From Big Medical Encyclopedia

BODY SCHEME — the difficult synthetic image of own body and its parts which is formed in a brain of the person on the basis of perception, feeling of kinaesthetic, tactile, pain, vestibular, visual, acoustical and other stimulations in comparison to traces of last touch experience. The term is entered by P. Schilder.

Page of t. matters in formation of a pose and movements (see. Movements , Pose , Postural reflexes ), regulated as conscious (see. Consciousness ), and unconscious reflex mechanisms. In space medicine the concept «body scheme» is used during the studying of relationship in system of people — the spaceship — surrounding space.

Fiziol. S.'s basis of t. the functional system integrating a flow of afferent impulses makes (see. Sensitivity ) from own body and its parts. In this functional system the dynamic, three-dimensional and space image of a body created by the current afferent impulses and a static image of a body, some kind of set of standards of poses, provisions of a body acquired in ontogenesis by training at a basis of long-term memory are integrated.

Page of t. forms with age, gradually; children up to 5 years have no completely created image of the body yet. Page of t. forms at the child concerning the right half of a body earlier, and soon then and concerning left.

In a wedge, neurology and psychiatry use a concept of disturbances of S. of t.: a syndrome of the distorted perception, feelings of the body, its size, a form, weight, position in space, a condition of rest or the movement. And perhaps distorted feeling both an image of all body, and its parts.

G. Ged considered an image of a body as the unity synthesized in a cerebral cortex caused by last experience and the current feelings of the subject. Pettsl (O. of Potzl) attached special significance in mechanisms of disturbances of S. of t. to a local factor, namely focal defeats of a parietal lobe. S. V. Babenkova on the basis of comparison a wedge, pictures of focal vascular defeats of the right and left cerebral hemispheres established that many symptoms of disturbance of S. of t. arise at focal defeats of the right hemisphere, a cut on this basis can be considered as dominant concerning a gnozis (knowledge) of own body. At the heart of a pathogeny of disturbances of S. of t. reversible and irreversible changes in the central nervous system lie, it is preferential in talamopariyetalny system. Reversible changes cause passing disturbances of S. of t., and irreversible — resistant.

Disturbances of a body scheme at nevrol. diseases can be caused by focal defeats of cerebral hemispheres, a vascular, infectious, tumoral etiology or the destructive and limiting intracranial space processes of other origin, at the same time especially large role is played by defeats of bark of supramarginal and angular crinkles of a parietal lobe. It speaks fiziol. a role of nizhnetemenny area of the cerebral cortex, generally right hemisphere integrating afferent flows of impulses from many analyzers and being thus polianalizatorny. Conditions for emergence of disturbances of S. of t. create also disorders of the coordinated activity of hemispheres and existence of all-brain symptoms.

To the most often meeting a wedge. to symptoms of disturbances of S. of t. the following belongs.

1. An anosognosia — neoconsciousness of the arisen dysfunction of any body or an extremity as one of types agnosias (see). At focal defeats of the right cerebral hemisphere neoconsciousness of the motive disturbances which are available for the patient is quite often observed. So, e.g., the patient can claim that he normally owns extremities, to-rye are actually paralyzed; observations of neoconsciousness of a blindness and disturbances of other functions are known a wedge.

2. An autotopagnosia — neoconsciousness of an arrangement in space of parts of the body. Thereof the patient, e.g., can look for the paralyzed hand actually lying on his breast under a pillow.

3. Manual agnosia — disturbance of recognition, the choice and correctness of display of fingers of hands, both own, and other people.

4. Disturbance of orientation in the right and left parties.

5. A pseudomelia — false sensation of absence (pseudo-amelia) or existence of an excess, illusory extremity, sometimes several such extremities (pseudopolymelia).

6. Feeling of the phantom of the amputated extremity when the victim with a remote extremity continues to feel it as existing.

7. Symptoms of a touch inattention: the patient ignores a field of vision of the left eye, puts on trousers only the right leg, persistently ignoring at the same time the left leg, etc.; at a simultaneous prick in symmetric places of the right and left half of a body the prick on the left side at preservation of sensitivity is not perceived, ignored by the patient.

8. The symptom of alienation of the paralyzed extremity, at Krom of the patient perceives it as others.

Less often other phenomena of touch disturbances meet. E.g., an allesteziya when at pain stimulation of a sore extremity pain is felt in healthy; an allokhey-riya — not distinguishing of the side of a body, on to-ruyu is put irritation. Separate symptoms of disturbance of S. of t. are a part of an apraktognostichesky syndrome of Ekaen (N. of Hecaen, 1956) including left-side space agnosia, an autotopagnosia, a dizleksiya, an acalculia and the center of defeat in a zone of supramarginal, angular crinkles of a parietal lobe and an upper temporal crinkle of the right cerebral hemisphere which is observed at localization. Symptoms of disturbance of S. of t. enter the developed syndrome of defeat of the right hemisphere and are quite often combined with confabulations (see. Konfabulez ), psevdorem nistsention (see. Paramnesias ), euphoria (see. Psychoorganic syndrome ), somnolence, automatic gesticulation, psychomotor excitement, a disorientation in time. S.'s disturbances t. at localization of the center in the left parencephalon are observed quite seldom. Disturbance of the right-left orientation is usually shown at simultaneous focal defeat of both hemispheres. In combination with symptoms of defeat of the motive, sensitive and reflex sphere of disturbance of S. of t. play an important role in topical diagnosis of the center of defeat.

Disturbances of a body scheme at mental diseases, napr, at schizophrenia, can be shown by distortion of feeling of a form, size or body weight. At total frustration of S. of t. size, and it is frequent and body weight are perceived sick as sharply increased or reduced. In some cases patients have a feeling that his body increased so that occupies all room where there is a patient, or decreased to the sizes of a body of the newborn; patients also claim that body weight increased to several honeycombs kilograms or feel a body weightless. At partial disturbances of S. of t. patients have a feeling that separate parts of a body are extended or shortened; patients speak about increase or reduction of volume of the head, a thickening of language, sharp increase or reduction of one or several extremities. More rare are frustration, at to-rykh the patient feels alienation of separate parts of a body, to-rye exist as if separately, or in representation of the patient double. In most cases at patients the critical relation to S.'s frustration of t remains.

S.'s disturbance t. can be the only symptom which is quite often arising at the time of backfilling or awakening, sometimes at a certain position of a body. S.'s disturbance t. at a mental disease it is possible both in the form of a stationary state, and in the form of an episode, a paroxysm. They are often combined with the phenomena of metamorphopsias and depersonalizatsionny frustration (see. Depersonalization ), and also are observed in structure of difficult syndromes: affective, hallucinatory-dilision, conditions of stupefaction. In some cases S.'s frustration t. can gain the nature of «perfection» that allows to carry them to the phenomena of mental automatism (see. Kandinsky — Klerambo a syndrome ). In these cases the critical relation to S.'s frustration of t. no. S.'s frustration t. it is necessary to distinguish from the phenomena metamorphopsias (see), at to-rykh changes of perception of size or a form of objects, and also surrounding space and from the phenomena of depersonalization are observed, at to-rykh change of the I is noted.

Bibliography: Babenkova S. V. Clinical syndromes of defeat of the right parencephalon at an acute stroke, M., 1971; Bekhterev V. M. Pseudopoli-melia paraesthetica in the form of imaginary members, Obozr. psikhiat., nevrol. and ekspery, psikhol., No. 4, page 236, 1926; M e r and - I would be A. A N. Depersonalization, Yerevan, 1962; it, General psychopathology, M., 1972; M e e r about in and the p R, I. Frustration of «body scheme» at mental diseases, JI1948, bibliogr.; R about in and nanosecond to and I am S. A. The characteristic of disturbances of a body scheme at diencephalic and trunk defeats of infectious genesis, Zhurn. neuropath, and psikhiat., t. 68, century 12, page 1788, 1968, bibliogr.; Stolyarova L. G. and Sidorovskaya M. D. To a question of disturbance of a body scheme, Owls. medical, N ° 3, page 99, 1964, bibliogr.; Evolution of functions of parietal shares, under the editorship of A.S. Batuyev, L., 1973; In a b i n s k i J.& Contribution l’ 6tude des troubles mentaux dans of l'h£miplegie organique of c£r6brale (anosogno-sie), Rev. neurol., p. 845, 1914; Schil-d e r P. Das Korperschema, B., 1923.

L. A. Kukuyev; A. S. Tygans (psikhiat.).